General practitioners (GPs) have an essential role in the diagnosis and ongoing care of patients with acute, chronic and progressive haematological conditions. Full blood count and blood chemistry are some of the most common pathology tests ordered in general practice and venesection is a common office-based procedure.1 When combined with history-taking and examination, these investigations are vital to identifying underlying blood disorders.2-4
Blood and metabolic disorders contribute 1.3% of the total burden of disease and 4.1% of health expenditure in Australia.5 Of these, anaemia is a major contributing factor, affecting almost half a million people;6 in contrast, hereditary haemochromatosis (HHC) affects an estimated one in 250 individuals of northern European backgrounds.7 Haematological malignancies account for approximately 11% of all cancers.8
One of the most common haematological presentations in general practice is iron deficiency anaemia. Causes of iron deficiency range from menorrhagia to worm infestation to nutritional deficiency. Iron deficiency is also implicated in other medical conditions like restless legs and heart failure. GPs play an important role in evaluating and managing iron deficiency. It can develop silently with non-specific symptoms9 and is often not the primary reason for a patient’s presentation. Approximately 9% of hospitalisations for potentially preventable conditions are related to iron deficiency anaemia.6 Anaemia is more common among Aboriginal and Torres Islander peoples when compared to non-Indigenous Australians,10 especially anaemia related to nutritional deficiencies and chronic kidney disease.11,12 Pre-operative anaemia is associated with adverse post-operative outcome.13 Regular and scheduled health assessments and antenatal care provide an opportunity to identify patients at risk of anaemia, highlighting the importance of the relationship between the GP, patient, their family and the community.14
GPs also play an important role in diagnosing blood cancers based on a patient’s symptoms and risk factors. The combination of hypercalcaemia, anaemia and kidney dysfunction, with or without bone pain, especially in elderly individuals, can indicate an underlying myeloma.15 In young patients, recurrent non-specific symptoms like general constitutional symptoms with anaemia, increased susceptibility to infections and increased bleeding and bruising, should raise suspicion of an acute leukaemia.9
Bleeding and clotting disorders can be acquired or familial. They are often associated with comorbidities like systemic lupus erythematosus (SLE) or be secondary to other medical conditions like malignancies.16 With increasing diversity in the Australian population, the incidence of inherited haemoglobinopathies like thalassaemia and sickle cell disease is likely to become more prevalent.17 Thrombosis is a common presentation in general practice, making diagnosis and management an essential competency. Screening for an underlying coagulopathy or a prothrombotic state7 according to clinical guidelines is also an important part of the GP’s role.